Abstract
Simple SummaryThis study aimed to investigate the effect of certain pre-operative parameters from the clinical routine directly on the post-operative intensive care unit (ICU)-length of stay (LOS) after major oral and maxillofacial cancer surgery. This study was performed to identify at-risk patients that are expected to need prolonged specialized care management post-operatively to these aforementioned operations. A homogenous cohort of 122 patients over a five year period was included in this study. At-risk patients are prone to need a significantly longer specialized care management than others. These patients are those with pre-operative severe renal dysfunction, peripheral vascular diseases and/or increasing heart failure stage categories. Confounding parameters that contribute to a prolonged specialized post-operative management in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.Objective: This study aimed to investigate the effect of certain pre-operative parameters directly on the post-operative intensive care unit (ICU)-length of stay (LOS), in order to identify at-risk patients that are expected to need prolonged intensive care management post-operatively. Material and Methods: Retrospectively, patients managed in an ICU after undergoing major oral and maxillofacial surgery were analyzed. Inclusion criteria entailed: age 18–90 years, major primary oral cancer surgery including tumor resection, neck dissection and microvascular free flap reconstruction, minimum operation time of 8 h. Exclusion criteria were: benign/borderline tumors, primary radiation, other defect reconstruction than microvascular, treatment at other centers. Separate parameters used within the clinical routine were set in correlation with ICU-LOS, by applying single testing calculations (t-tests, variance analysis, correlation coefficients, effect sizes) and a valid univariate linear regression model. The primary outcome of interest was ICU-LOS. Results: This study included a homogenous cohort of 122 patients. Mean surgery time was 11.4 (±2.2) h, mean ICU-LOS was 3.6 (±2.6) days. Patients with pre-operative renal dysfunction (p < 0.001), peripheral vascular disease-PVD (p = 0.01), increasing heart failure-NYHA stage categories (p = 0.009) and higher-grade categories of post-operative complications (p = 0.023) were identified as at-risk patients for a significantly prolonged post-operative ICU-LOS. Conclusions: At-risk patients are prone to need a significantly longer ICU-LOS than others. These patients are those with pre-operative severe renal dysfunction, PVD and/or high NYHA stage categories. Confounding parameters that contribute to a prolonged ICU-LOS in combination with other variables were identified as higher age, prolonged operative time, chronic obstructive pulmonary disease, and intra-operatively transfused blood.
Highlights
The surgical treatment of advanced oral cancer often requires extensive resections in the head and neck area and the oral cavity [1,2,3]
Since the primary outcome parameter of this study was intensive care unit (ICU)-length of stay (LOS), we focused on patients that were postoperatively admitted to ICU
At-risk patients are prone to needing significantly longer ICU-management periods than others. These patients are those with pre-operative severe renal dysfunction, peripheral vascular disease (PVD), and/or high NYHA stage categories
Summary
The surgical treatment of advanced oral cancer often requires extensive resections in the head and neck area and the oral cavity [1,2,3]. Optimal measures for post-operative care following head and neck free flap reconstructions have already been discussed in the literature, and current trends are moving from routine ICU admission to immediate specialty unit recovery, the postoperative ICU admission rates and requirements still vary from one clinical center to another and, even within clinical institutions [10,11] In this regard, it was shown that postoperative patient management in these complex head and neck cancer surgery patients can be performed safely in non-ICU specialty wards [12], that the majority of reconstructive surgeons will still send their patients to the ICU for the immediate postoperative period [11]. Several studies have already focused on ICU-LOS and overall hospital LOS regarding specific advantages and disadvantages of ICU vs. non-ICU specialty wards, different sedation protocols, risk factors for post-operative complications, the effects of ICU staffing, the incidence of post-operative delirium and complex co-morbidity and mortality scores [9,11,17,18,19,20,21,22,23]
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